Shiga-toxin producing E. coli (STEC)

Action requested: Consider STEC infection in persons with diarrhea and who have recently eaten food from Chipotle restaurants.

Background: As of October 30, 2015, 19 cases of STEC had been reported in King, Skagit, Clark, and Cowlitz counties; additional cases have been reported in Oregon. Although the outbreak appears to be linked to food served at Chipotle restaurants, the food or other source of contamination hasn’t yet been determined and remains under investigation. Chipotle restaurants in Washington State have voluntarily closed until further information on the cause of the outbreak is available.

Recommendations:

Consider STEC infection in all persons with bloody diarrhea and in persons with bloody or non-bloody diarrhea and a history of food from Chipotle restaurants during the exposure period (usually 3-4 days, but may be 1-10 days).

In patients with symptoms compatible with STEC infection, collect a stool specimen and request E. coli testing by culture and Shiga toxin test.

If bloody diarrhea is present, laboratory evaluation should include a complete blood count, serum electrolytes, BUN, and creatinine.

Shiga toxin immunoassays should be obtained in addition to cultures, but should not replace culture on a sorbitol MacConkey agar plate.

Report confirmed or suspected STEC cases immediately to the Health District (425-339-5278). Obtain the following history during the exposure period (1 to 10 days before symptom onset):

Dietary history, travel history with travel dates and destinations, and history of animal exposures (pets, farms, etc.).